Countering Industry Messaging

Smokers and other tobacco users regularly state that the advice of a physician or health expert is important to them. In fact, one study found that the majority of parents would be more satisfied with their child’s pediatric office visit if the doctor discussed their tobacco use and how it could negatively impact their child. It is important to address cessation of tobacco use in all encounters with a tobacco user; otherwise it may appear as if the clinician condones the behavior. Electronic nicotine delivery systems (ENDS, or e-cigarettes), which are not approved by the US Food and Drug Administration as an approved cessation device, should not be recommended to help smokers quit.

Clinicians should be clear in their messages about tobacco use and secondhand smoke exposure with both children and families. Adult tobacco users should be advised to quit and given proper materials to do so, or at the very least, encouraged to work with the clinician to think of ways to protect the rest of the family from the toxins in secondhand smoke. Helpful cessation materials may include the state quitline, web sites, text-to-quit programs, apps, in-person programs, and nicotine replacement therapy such as medication, patches, lozenges, or gum. The adoption of smoke-free rules in homes and cars is one way a tobacco user who will not quit can still protect the rest of the family. Adolescent tobacco users should also be advised to quit, and given age-appropriate motivators to do so. Electronic nicotine delivery systems (ENDS, or e-cigarettes), which are not approved by the US Food and Drug Administration as an approved cessation device, should not be recommended to help smokers quit.

If the exposure to secondhand smoke is not under the parent’s control, the clinician should encourage the parents to consider having a discussion with the person causing the secondhand smoke exposure. If the parents seem anxious about facilitating this conversation, the clinician should suggest that they bring the smoker(s) to an appointment so that the dangers posed to the family from secondhand smoke can be discussed.

Clinicians should understand, and be prepared to discuss, that some patients and family members may be dual tobacco product users, or part of a demographic group which puts them at a higher risk for tobacco use.

Each time a clinician discusses tobacco use with a patient or family member, it should be documented. Even if a family member reports that they smoke outside and away from the children in the family, it should be documented in the child’s chart. Living with a smoker does pose a risk to a child’s health, no matter where the smoking occurs.

It is important that clinicians ask the right questions of their patients and families. Asking “you don’t smoke, do you?” may sound judgmental and may not get at the right information. Someone who uses a product other than cigarettes (smokeless tobacco, cigars, hookah, electronic nicotine delivery systems) may not answer yes to this question. Try asking broad questions, but give specific examples- “Do you use any form of tobacco like cigarettes, cigars, dip, or hookah? Do you use any type of electronic smoking device like an e-cigarette or vaping device?”

Clinicians are under constant time constraints. It may be difficult to address tobacco use and exposure with a patient or patient’s family if there is no time, or no benefit to the clinician. Clinicians should be sure to code properly for the valuable time spent on counseling a patient or family about tobacco use and exposure. Also consider using tobacco exposure as a risk factor when justifying other potentially related illnesses, such as asthma and other respiratory problems.

Clinicians should make it as easy as possible for tobacco users to quit by providing access to cessation resources. Helpful cessation materials may include the state quitline, web sites, text-to-quit programs, apps, in-person programs, and nicotine replacement therapy such as medication, patches, lozenges, or gum. Clinicians can also offer handouts to patients and families to educate and support them in their cessation efforts and can refer a tobacco user to national and state quitlines or prescribe pharmacotherapy, even if that person is not their patient. Electronic nicotine delivery systems (ENDS, or e-cigarettes), which are not approved by the US Food and Drug Administration as an approved cessation device, should not be recommended to help smokers quit.

Clinicians should understand, and be prepared to discuss, that some patients and family members may be dual tobacco product users, or part of a demographic group which puts them at a higher risk for tobacco use.

Clinicians should adopt the practice of referring tobacco users to cessation resources, whether the user is their patient or not. There are both national and local resources available to assist in cessation efforts. Helpful cessation materials may include the state quitline, web sites, text-to-quit programs, apps, and in-person programs. Local resources, such as a state quitline, or a community organization, may be more culturally sensitive to a specific region or ethnic group than more generalized, national resources.

Patients are more likely to accept advice from health care professionals who practice what they preach. Clinicians should not give patients or their families any excuses to dismiss the cessation advice of members of the health care team. Management should encourage all employees to stop using tobacco products, incentivize their cessation efforts by encouraging them to maintain a tobacco-free lifestyle, and provide cessation materials to staff whenever possible. Electronic nicotine delivery systems (ENDS, or e-cigarettes), which are not approved by the US Food and Drug Administration as an approved cessation device, should not be recommended to help smokers quit.

Motivational interviewing is an effective technique to discuss tobacco use with a patient or family. Using this or similar methods, which have been proven to be successful, may double the chance of a tobacco user listening to and effectively acting on cessation recommendations.